Term
AR/ VMR/ Both
Intranasal corticosteroid |
|
Definition
|
|
Term
AR/ VMR/ Both
Intranasal antihistamine |
|
Definition
|
|
Term
AR/ VMR/ Both
oral antihistamine |
|
Definition
|
|
Term
AR/ VMR/ Both
Decongestant |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
AR/ VMR/ Both
Ipratropium bromide |
|
Definition
|
|
Term
AR/ VMR/ Both
nasal saline |
|
Definition
|
|
Term
AR/ VMR/ Both
Oral corticosteroids |
|
Definition
|
|
Term
| What is the treatment plan for episodic AR? |
|
Definition
treat the symptoms
nasal decongestant, nasal antihistamine, oral antihistamine, eye drops, or nasal saline |
|
|
Term
| What is the treatment plan for mild persistent allergic rhinitis? |
|
Definition
1 regular medication
nasal corticosteroid or nasal antihistamine
monetlukast, ipratropium bromide |
|
|
Term
| What is the treatment plan for mild to moderate persistent allergic rhinitis? |
|
Definition
2 regular medications
nasal corticosteroid and nasal antihistamine
oral antihistamine, montelukast |
|
|
Term
| What is the treatment plan for moderate to severe allergic rhinitis? |
|
Definition
2-3 medications
nasal corticosteroid and nasal antihistamine
montelukast, ipratropium bromide, oral antihistamine, nasal saline |
|
|
Term
| What is the treatment plan for severe persistent allergic rhinitis? |
|
Definition
| continue all regularly used medications and add short term use corticosteroids |
|
|
Term
| How long should you use corticosteroids to treat severe persistent allergic rhinitis? |
|
Definition
Dose packs for 5-7 days
4x per year (no more than every 3 months) |
|
|
Term
|
Definition
prescription NSAID eye drop
relieves ocular itching |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
OTC
antihistamine and mast cell stabilizer |
|
|
Term
|
Definition
Rx
antihistamine and mast cell stabilizer |
|
|
Term
|
Definition
antihistamine and vasoconstricter
limit to 2-3 days because of the naphazoline |
|
|
Term
| naphazoline + pheniramine |
|
Definition
antihistamine and vasoconstrictor
limit to 2-3 days because of naphazoline |
|
|
Term
|
Definition
1st gen oral antihistamine
causes drowsiness |
|
|
Term
|
Definition
1st gen oral antihistamine
less drowsy than diphenhydramine |
|
|
Term
|
Definition
| 1st gen oral antihistamine |
|
|
Term
|
Definition
| 1st gen oral antihistamine |
|
|
Term
|
Definition
Rx
1st gen oral antihistamine
antiemetic, sedative, anxiolytic |
|
|
Term
T/F
First gen oral antihistamines cross the blood brain barrier because they are lipid soluble. |
|
Definition
|
|
Term
| What cardiovascular effects do first gen oral antihistamines have? |
|
Definition
| increase BP and cause prolonged QT interval |
|
|
Term
|
Definition
| 2nd gen oral antihistamine |
|
|
Term
|
Definition
2nd gen oral antihistamine
> 12 180 mg QD
doesn't have a lot of drug-drug interactions |
|
|
Term
|
Definition
2nd gen oral antihistamine
2 mo.s-5 yrs 2.5 mg PO QD |
|
|
Term
|
Definition
| 2nd gen oral antihistamine |
|
|
Term
|
Definition
2nd gen oral antihistamine
> 6 yrs 5 mg PO QPM |
|
|
Term
T/F
There are cardiovascular effects produced by second gen oral antihistamines. |
|
Definition
|
|
Term
| How are second gen nasal antihistamines dosed? |
|
Definition
| 1-2 sprays each nostril BID |
|
|
Term
azelastine hydrochloride
(saline) |
|
Definition
2nd gen nasal antihistamine
bitter taste
approved for age 5 and up |
|
|
Term
azelastine hydrochloride
(sucralose/sorbitol) |
|
Definition
2nd gen nasal antihistamines
approved for age 12 and up |
|
|
Term
|
Definition
2nd gen nasal antihistamine
age 12 and up |
|
|
Term
|
Definition
nasal steroid
seasonal and perennial allergic and nonallergic rhinitis |
|
|
Term
fluticasone furoate
(dose) |
|
Definition
nasal steroid
2-11 years: 1 spray per nostril QD-BID
Adults: 2 sprays per nostril BID |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
nasal steroid - AQ prep
2-11 years: 1 spray each nostril QD
adults: 2 sprays each nostril QD |
|
|
Term
|
Definition
|
|
Term
| beclomethasone diproponate |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
mast cell stabilizer
begin 1 week before to prevent symptoms of allergic rhinits
Side effects: nasal stinging, sneezing |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
anticholinergic agent
side effects: nasal dryness, epistaxis, headache |
|
|
Term
|
Definition
leukotriene receptor blocker
2-5 years - 4 mg PO QHS
6-14 years - 5 mg PO QHS
Adults - 10 mg PO QD |
|
|
Term
|
Definition
leukotriene receptor blocker
hepatotoxicity |
|
|
Term
|
Definition
leukotriene receptor blocker
hepatotoxicity |
|
|
Term
| Name 2 causative agents of folliculitis? |
|
Definition
| Staph. aureus and Pseudomonas aeruginosa |
|
|
Term
| What oral antibiotic will resolve folliculitis? |
|
Definition
|
|
Term
| What OTC topical agents are used to treat folliculitis? |
|
Definition
| bacitracin/neomycin/polymyxin B (Neosporin) and bacitracin zinc/polymyxin B sulfate (Betadine Brand) |
|
|
Term
| What Rx topical agents are used to treat folliculitis? |
|
Definition
| acne preparations such as benzoyl peroxide (Benzac), doxycycline (Doryx), and clindamycin/benzoyl peroxide (Benzaclin); or mupirocin (Bactroban, Centany) |
|
|
Term
| How do you treat extensive folliculitis? (hot tubitis?) |
|
Definition
| systemic antibiotic - cephalexin (Keflex) |
|
|
Term
| What is mupirocin (Bactroban nasal) used for? |
|
Definition
|
|
Term
| What is furuncle treatment for a closed lesion? |
|
Definition
| Broad spectrum abx for 7-10 days; RTC in 5-9 days for incision and drainage - remove the lesion as an intact mass |
|
|
Term
| How do you treat a carbuncle? |
|
Definition
| clean the area daily with soap and water; sterile dressing if purulence; mupirocin to open wounds; wound culture; abx - fluoroquinolone, tetracycline, or amoxicillin/clavulanate |
|
|
Term
| What typically causes bullous erysipelas? |
|
Definition
|
|
Term
| What is the treatment for bullous erysipelas? |
|
Definition
rupture of bullae, debridement, and compression stockings
cephalexin |
|
|
Term
| What is the treatment for impetigo? |
|
Definition
| clean the area daily - not with topical disinfectant; mupirocin, retapamulin - ointments or cephalexin, dicloxacillin - oral abx |
|
|
Term
| What is the treatment for lymphangitis? |
|
Definition
| immobilizaion and elevation of the infected area; parenteral abx - penicillin, then after fever abates switch to oral penicillin for 10 days |
|
|
Term
| How do you treat cellulitis? |
|
Definition
| cephalexin (Keflex), amoxicillin/clavulanate (Augmentin), or tirmethoprim/sulfamethoxazole (Bactrim) |
|
|
Term
| How do you treat serious cellulitis? (orbital cellulitis or large areas of infection) |
|
Definition
|
|
Term
| What is the treatment for diabetic foot ulcers? |
|
Definition
PREVENTION
Rule out osteomyelitis
Oral broad specrum antibiotic - fluoroquinolone, amoxicillin/clavulanate
Debridement of the wound to bleeding margins
Daily care |
|
|
Term
| How long do you dose an oral abx for a diabetic foot ulcer? |
|
Definition
| 10-14 days, if no S/S of infection, discontinue |
|
|
Term
| What is a more intense treatment for diabetic foot ulcers? |
|
Definition
| becaplermin (Regranex) 0.1% gel |
|
|
Term
| What is in becaplermin (Regranex) 0.1% gel? |
|
Definition
| platelet-derived growth factors (PDGFs); these recruit cells around the ulcer and initiate the second phase of healing - proliferation |
|
|
Term
| What is important to note about becaplermin (Regranex)? |
|
Definition
| It is a 12-hour topical treatment. Apply it in the AM and remove in the PM. Use an abx cream/ointment at night. |
|
|
Term
|
Definition
Mycobacterium tuberculosis
Mycobacterium bovis |
|
|
Term
| How do you read a TST (or PPD)? |
|
Definition
Look and feel for induration. Mark the induration with a pen and measure
>15 mm is +
>10mm in an exposed, diabetic, or kidney disease individual is +
>5mm in an immunocompromised individual is + |
|
|
Term
| What is the first phase of treatment for TB? |
|
Definition
| 8 weeks of daily therapy with isoniazid, rifampin, ethambutol, and pyrazinamide |
|
|
Term
| What is the second phase of treatment? |
|
Definition
18 weeks (daily, 5x/week, or 3x/week) of meds depending on the initial response
31 weeks for phase 2 if cavitation on initial CXR |
|
|
Term
| What are considered the first line therapies for TB? |
|
Definition
| isoniazid, rifampin, amikacin, and kanamycin, ethambutol, pyrazinamide, rifabutin |
|
|
Term
| What are possible side effects of isoniazid? |
|
Definition
| fever, skin rashes, drug induced hepatitis |
|
|
Term
| What are the side effects of rifampin? |
|
Definition
| orange color to urine, sweat, tears, and contact lenses; rashes, thrombocytopenia (anemia), and nephritis |
|
|
Term
| What drugs used to treat TB can cause drug-induced hepatitis? |
|
Definition
| isoniazid, rifampin, pyrazinamide |
|
|
Term
| What happens if you use isoniazid with phenytoin? |
|
Definition
| you get increased levels of both drugs |
|
|
Term
| What TB drug should not be used in children and why? |
|
Definition
| ethambutol because of risk of diminished visual acuity |
|
|
Term
| What drug regimen do you use to treat children with TB? |
|
Definition
isoniazid, rifampin, and pyrazinamide
and 4th if there is severe pulmonary disease |
|
|
Term
| What is the 3 drug regimen used to treat active TB in pregnant women? Why are these used? |
|
Definition
isoniazid, rifampin, and ethambutol
they are used because of their lack of teratogenic effects |
|
|
Term
| When a TB patient is in advanced liver disease, which drug(s) do you use? |
|
Definition
|
|
Term
| What medications do you use to treat HIV patients with TB? |
|
Definition
| same drugs as with non-HIV patients, except if the patient is on antivirals, in which case - no rifampin |
|
|
Term
| What 3 drugs may increase risk of latent TB becoming active TB? How do they cause this? |
|
Definition
infliximab, etanercept, or adalimumab
they inhibit tumor necrosis factor alpha |
|
|
Term
| How must isoniazid be taken? |
|
Definition
| on an empty stomach, and no antacids for 2 hours |
|
|
Term
| What is the treatment for resistant TB? |
|
Definition
| isoniazid, rifampin, pyrazinamide, + 2 or 3 additional agents |
|
|
Term
| What are the 3 most common bacteria in AOM? |
|
Definition
1. Strep pneumoniae 40-50%
2. Haemophilis influenzae 30-40%
3. Moraxell catarrhalis 10-15% |
|
|
Term
| What 3 factors must be present in order to diagnose OM? |
|
Definition
1. History of acute onset
2. Signs of middle ear effusion - immobile, bulging TM
3. Middle ear inflammation - erythema of the TM, otalgia |
|
|
Term
| What is the first line of treatment for uncomplicated AOM? |
|
Definition
1.
Amoxicillin - safe, inexpensive, acceptable taste, and narrow microbiologic spectrum |
|
|
Term
| What is the low dose of amoxicillin for AOM? High dose? |
|
Definition
40-45 mg/kg/day in divided doses BID x 10 days
80-90 mg/kg/day in divided doses BID x 10 days |
|
|
Term
| What is the dosing for amoxicillin/clavulanate for AOM? |
|
Definition
1. amoxicillin 80-90 mg/kg/day
2. clavulanate 6.4 mg/kg/day
3. divided doses BID x 10 days |
|
|
Term
| What is the dosing of Clindamycin for AOM after treatment failure? |
|
Definition
| 17-25 mg/kg/day in 3-4 doses x 10 days |
|
|
Term
| What abxs are used to treat OE> |
|
Definition
Colistin/neomycin/hydrocotisone
ofloxacin
ciprofloxacin/dexamethasone |
|
|
Term
| What is a contraindication for the use of colistin/neomycin/hydrocortisone? |
|
Definition
|
|
Term
| Which medication is approved for treatment of OE with perforated TM? |
|
Definition
|
|
Term
| When is ciprofloaxin/dexamethasone (steroid) contraindicated? |
|
Definition
| viral or fungal infection |
|
|
Term
| How do you treat fungal OE? |
|
Definition
2% acetic acid solution
1% clotrimazole
tolnafate |
|
|
Term
| How many days must a patient be symptomatic before it is no longer assumed to be VIRAL rhinosinusitis? |
|
Definition
|
|
Term
| hat meds are useful for rhinosinusitis? |
|
Definition
oxymetazoline
phenylephrine
azelastine
use 1-3 days only |
|
|
Term
| What 4 items are on the diagnostic point system for acute bacterial rhinosinusitis? |
|
Definition
1. purulent nasal discharge - worse on one side
2. bilateral rhinorrhea
3. unilateral maxillary sinus tenderness (or frontal sinus tenderness)
4. Pus in the nasal cavity on examination |
|
|
Term
| How do you treat ABRS in peds? |
|
Definition
1. high dose amoxicillin
2. high dose amoxicillin/clavulanate
3. cefidinir
4. clindamycin |
|
|
Term
| How do you treat ABRS in adults? |
|
Definition
1. high dose amoxicillin or amoxicillin/clavulanate
2. cefpodoxine
3. moxifloxacin
4. clarithromycin |
|
|
Term
| What is the first line of therapy for ABRS? |
|
Definition
|
|
Term
| If a patient is allergic to penicillins, what do you use to treat ABRS? |
|
Definition
| trimethoprim/sulfamethoxazole or a macrolide |
|
|
Term
| If a patient has used abx in the last 4-6 weeks, what do you use to treat ABRS? |
|
Definition
1. fluoroquinolone
2. high dose amoxicillin/clavulanate |
|
|
Term
| What is included in the diagnostic point system for GABHS pharyngitis? |
|
Definition
1. Tonsilar exudates
2. absence of cough
3. tender anterior cervical lymph nodes
4. history of fever >100.4
5. <15 years
6. >45 years |
|
|
Term
| What is the DOC for GABHS pharyngitis? |
|
Definition
1. penicillin G bezathine IM
2. Penicillin VK in adults
3. Macrolide for penicillin allergy - clarithromycin |
|
|
Term
| What might you use to treat watery, itchy eyes? |
|
Definition
olopatadine
azelastine
both are antihistamine and mast cell stabilizers |
|
|
Term
| How long is the treatment course for bacterial UTI? |
|
Definition
|
|
Term
| Why do we use 1 day treatments for bacterial UTI if they are less effective than longer treatments? |
|
Definition
| longer treatments have higher risk for adverse effects and are not very much more effective. |
|
|
Term
| How long is the treatment course for complicated UTI? |
|
Definition
7-14 days
except Nitrofurantoin 7-10 days - safe to use in pregnant women |
|
|
Term
| What is a urine dip test done to detect? |
|
Definition
| presence of leukocyte esterase, presence of blood, presence of nitrates |
|
|
Term
| What is the most common cause of uncomplicated UTI? |
|
Definition
|
|
Term
| Name some bacteria that may be the cause of complicated urinary tract infection. |
|
Definition
| Staphylococcus saprophyticus (gram +), enterobacteria (Klebsiella or Proteus) |
|
|
Term
| What is the empiric treatment for women with suspected UTI? |
|
Definition
trimethoprim/sulfamethoxazole 3 days
ciprofloxacin 3 days |
|
|
Term
T/F
History and physical exam trump dipstick analysis when it comes to diagnosing UTI. |
|
Definition
|
|
Term
| In microscopic analysis, what # of WBCs and RBCs indicate infection? |
|
Definition
|
|
Term
|
Definition
| Pyridium - a urinary analgesic |
|
|
Term
| What is the treatment for acute uncomplicated cystitis? |
|
Definition
trimethoprim/sulfamethoxazole 800/160 mg bid x 3days
ciprofloxacin 250 mg bid x 3 days
fosfomycin 1 day
nitrofurantoin 100 mg bid x 7 days
cephalexin
amoxicillin/clavulanate |
|
|
Term
| How is nitrofurantoin cleared from the body? |
|
Definition
| kidneys, so do not prescribe with creatinine clearance < 40 ml/min |
|
|
Term
| What are the side effects of nitrofurantoin? |
|
Definition
nausea and vomiting - 17% of patients
rash - 1%
rare
pulm hypersensitivity: acute fever, cough, dyspnea, myalgias, eosinophilia, infiltrates
pulm fibrosis: insidious onset, nonproductive cough, dyspnea, interstitial infiltrates
hemolytic anemia
peripheral neuropathy |
|
|
Term
| What 3 abx used for the treatment of UTI are pregnancy category B? |
|
Definition
| nitrofurantoin, fosfomycin, and cephalexin |
|
|
Term
| Which abx is the treatment of choice for UTI in pregnant women? Why? |
|
Definition
Nitrofurantoin - cat. B and cheap
fosfomycin is more expensive
cephalexin isn't as effective |
|
|
Term
| How does a UTI presentation differ in the elderly? |
|
Definition
| no fever, asymptomatic bacteriuria, altered mental status, change in eating habits, GI complaints |
|
|
Term
| How do you treat significant (max on urine dip) hematuria? |
|
Definition
| urinalysis, 10 days of tx with TMP/SMX and RTC to repeat urine dip |
|
|
Term
| What is the treatment for pyelonephritis in an immunocompetant patient that can tolerate oral therapy? |
|
Definition
ceftriaxone and levofloxacin
follow up in 24-72 hours |
|
|
Term
| How do you treat schistosomiasis? |
|
Definition
|
|
Term
| What is the treatment for acute prostatitis? |
|
Definition
| trimethoprim/sulfamethoxazole |
|
|
Term
| What is the treatment for chronic prostatitis? |
|
Definition
| same as UTI, but longer (4 weeks - 3 months) |
|
|
Term
| What is the treatment for infectious hematospermia? |
|
Definition
| 2 weeks of quinolone, trimethoprim/sulfamethoxazole, or doxycycline |
|
|
Term
| Between age 14-35 what are the most common causes of epididymitis? |
|
Definition
| N. gonorrhea or Chlamydia |
|
|
Term
| What is the most likely cause of epididymitis in men older than 35? |
|
Definition
|
|
Term
| How do you rule out testicular torsion when you suspect epididymitis? |
|
Definition
| pain with testicular elevation, acute onset of pain, epididymis appears normal, decreased blood flow on doppler |
|
|
Term
| What % of interstitial cystitis patients have therapeutic results from evaluation by hydrodistension? How long do the effects last? |
|
Definition
| 30-60% and last 2-8 weeks |
|
|
Term
T/F
Bronchitis is generally considered a viral etiology. |
|
Definition
|
|
Term
T/F
Pneumonia is generally considered a bacterial infection. |
|
Definition
|
|
Term
| How long does acute bronchitis last? |
|
Definition
|
|
Term
| What is the treatment for whooping cough? |
|
Definition
| Erythromycin (EES) 30-50 mg/kg/day as 3 divided doses x 10 days |
|
|
Term
| How soon should treatment be started with whooping cough? |
|
Definition
| macrolide should be started within the first 2 weeks |
|
|
Term
| How long should a patient with whooping cough be isolated? |
|
Definition
| first 5 days of treatment |
|
|
Term
| Name 3 primary bacterial agents that can cause acute bronchitis in rare cases. |
|
Definition
| Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordetella pertussis |
|
|
Term
| Name 3 causes of secondary bacterial infection in acute bronchitis. |
|
Definition
| Streptococcus ssp., Staphylococcus spp., Hemophilis spp. |
|
|
Term
| What is the treatment for acute bronchitis? |
|
Definition
| symptomatic and supportive care - fluids and bed rest, antipyretics, vaporizer to lessen respiratory secretions (especially in infants < 1 year) |
|
|
Term
| Where is acetominophen metabolized? |
|
Definition
|
|
Term
| Where is ibuprofen metabolized? |
|
Definition
|
|
Term
| What is the maximum dosage of acetominophen for an adult? |
|
Definition
short term 4g/day
long term 3g/day |
|
|
Term
| What characterizes Reye's syndrome? |
|
Definition
| severe increase of intracranial pressure and an abnormal accumulation of fat in the liver; first symptom is uncontrollable vomiting and nausea; swelling in the brain may cause seizures and the child may stop breathing |
|
|
Term
| How do you treat Reye's syndrome? |
|
Definition
| drugs to control the swelling in the brain and IV fluids to restore normal blood chemistry; ventilator to aid in breathing |
|
|
Term
| Name 3 cough suppressants used to treat acute bronchitis. |
|
Definition
| dextromethorphan, codeine, and hydrocodone |
|
|
Term
| How does dextromethophan work? |
|
Definition
| Penetrates the CNS to act on the brainstem to inhibit the cough center; inhibits glutamenergic synaptic transmission of inputs from sensory receptors in the airway as a result of facilitation of serotonergic mechanism |
|
|
Term
T/F
Expectorants are recommended for acute bronchitis. |
|
Definition
|
|
Term
| What do expectorants do to ease symptoms? |
|
Definition
| promote drainage of mucus from the lungs by thinning the mucus and lubricating the irritated respiratory tract |
|
|
Term
| What is the dosing for guafenesin (Mucinex)? |
|
Definition
|
|
Term
| What is benzonatate (Tessalon)? |
|
Definition
|
|
Term
| How do you dose benzonatate? |
|
Definition
100 mg perles bid-tid
Walmart $4 prescription |
|
|
Term
| What criteria are used to diagnose chronic bronchitis? |
|
Definition
| cough and sputum expectoration occurring on most days for at least 3 months of the year and for at least 2 consecutive years without the presence of other pulmonary or cardiac causes |
|
|
Term
| How do we treat chronic bronchitis? |
|
Definition
depends on classification 1, 2, or 3
symptomatic and supportive care, maybe antibiotics |
|
|
Term
|
Definition
|
|
Term
| How do you dose bronchodilators? |
|
Definition
| 2 puffs prn up to QID - if more than 1 is used, still QID TOTAL |
|
|
Term
| How do you dose duoneb (albuterol + ipratripium) updraft solution? |
|
Definition
|
|
Term
T/F
Abuterol is a short acting beta agonist. |
|
Definition
|
|
Term
T/F
While using beta agonists, it is important to avoid concomitant beta-blocker therapy. |
|
Definition
|
|
Term
| Why does albuterol have little effect on adrenergic receptors of the heart? |
|
Definition
| It is a selective better blocker, blocking beta2 receptors which relaxes the airway smooth muscle but not blocking beta1 receptors of the heart |
|
|
Term
| How does ipratropium bromide act as a bronchodilator? |
|
Definition
| it blocks the action of Ach at parasympathetic sites in bronchial smooth muscle |
|
|
Term
| What is the DOC bronchodilator for COPD patients? How is it dosed? |
|
Definition
albuterol + ipratropium bromide
2 puffs prn QID |
|
|
Term
| What is the antibiotic therapy for simple chronic bronchitis with mild symptoms? |
|
Definition
| no antibiotics, just symptomatic and supportive care |
|
|
Term
| What is the antibiotic therapy for simple chronic bronchitis with intense symptoms? Give dosage |
|
Definition
symptomatic and supportive care and antibiotics
azithromycin, 3 pack 500 mg po QD x 3 days
doxycycline
trimethoprim/sulfamethoxazole 800/160 mg po bid x 10 days |
|
|
Term
| How does trimethoprim/sulfamethoxazole work? |
|
Definition
| prevents bacterial proteins and nucleic acids from being synthesized |
|
|
Term
| What is the antibiotic therapy for chronic bronchitis with COPD and mild symptoms? |
|
Definition
| azithromycin, doxycycline, co-trimaxazole (bactrim DS) |
|
|
Term
| What is the antibiotic therapy for chronic bronchitis with COPD and severe symptoms? |
|
Definition
levofloxacin, 750 mg QD x 7 days
clarithromycin 500 mg ii tabs QD x 7 days |
|
|
Term
| What is the antibiotic therapy for chronic bronchitis with severe COPD and mild symptoms? |
|
Definition
levofloxacin
amoxicillin-clavulanate 1000/62.5 mg 2 tabs po q12h x 10 days |
|
|
Term
| What is the antibiotic therapy for chronic bronchitis with severe COPD and severe symptoms? |
|
Definition
consider hospitalization for IV abx as for pneumonia - run cultures
ceftriaxone 1 g IM with levofloxacin or Augmentin and follow up in 24 h. |
|
|
Term
| What age is the peak incidence of bronchioloitis? |
|
Definition
|
|
Term
| What 3 viruses account for most cases of bronchiolitis? |
|
Definition
|
|
Term
| What is the clinical presentation of bronchiolitis? |
|
Definition
prodrome - irritability, restlessness, mild fever (lasts 2-7 days)
dehydration - cough prevents fluid intake; emesis, diarrhea, fever
tachypnea (40- 80 RR)
labored breathing, retractions of the chest wall, nasal flaring, and grunting |
|
|
Term
| When are bronchodilators used in the treatment of bronchiolitis and why? |
|
Definition
| only for bronchospasm with clear therapeutic benefit because they may be detrimental to patients |
|
|
Term
| What treatment regimen helps reduce rate of hospital admission in bronchiolitis patients? |
|
Definition
epinephrine nebulizer treatment
dexamethasone shot then oral treatment for 5 days |
|
|
Term
| How is palivizumab given? |
|
Definition
| injection once a month for several months (max 3-5 doses) |
|
|
Term
| What is the most common cause of death from infection in the US? |
|
Definition
|
|
Term
| What are the 3 ways in which microorganisms access the lungs? |
|
Definition
1. inhaled aerosolized particles
2. through the blood stream from an extrapulmonary site of infection in sepsis
3. aspiration of oropharyngeal contents |
|
|
Term
| What is the most common cause of CAP? |
|
Definition
| Streptococcus pneumoniaee |
|
|
Term
| Why is urinary antigen detection for the C polysaccharide from the pneumococcal cell wall used to determine if someone has Strep. pneumoniae? |
|
Definition
| because it remains positive for weeks after initial symptoms and can be used after abx are begun |
|
|
Term
| How do you determine if someone has severe CAP? |
|
Definition
| One major criteria or 2 minor criteria |
|
|
Term
| What are the major criteria for determining severe CAP? |
|
Definition
serum p < 7.3
systolic pressure < 90 mm Hg |
|
|
Term
| What are the minor criteria for determining severe CAP? |
|
Definition
respirations > 30
BUN > 30
altered mental status
age > 80 years
multi-lobular/bilateral infiltrates on CXR
Pa02 < 54 mm Hg |
|
|
Term
| What is the outpatient abx therapy for adults with CAP? |
|
Definition
levofloxacin 750 mg QD x 10 days
gemifloxacin 320 mg po QD x 7 days
clarithromycin 500 mg ii tabs QD x 10 days |
|
|
Term
| What is the outpatient abx therapy for pediatrics with CAP? |
|
Definition
clarithromycin
amoxicillin/clavulanate
ceftriaxone |
|
|
Term
| What are the 2 pneumonia vaccines and when are they used? |
|
Definition
Pneumovax 23 - used in those with weakened immune systems and those over 65
Prevnar - covers 80% of pneumococcal infections in peds population
Also, yearly flu vaccine helps prevent pneumonia cases caused by flu |
|
|
Term
| What are 3 atypical pathogens that may cause pneumonia? |
|
Definition
| Mycoplasma penumoniae, Chlamydia pneumoniae, and Legionella pneumoniae |
|
|
Term
| How is Legionella pneumoniae spread? |
|
Definition
spray from stagnant water
no person to person spread
has 14% mortality rate |
|
|
Term
| How do you treat atypical pneumonia? |
|
Definition
levofloxacin
clarithromycin 500 mg ii tabs QD x 10 days
doxycycline |
|
|
Term
| How should nursing home acquired pneumonia be treated outpatient? |
|
Definition
levofloxacin or moxifloxicin
OR
amoxicillin/clavulanate or cefuroxime or cefpodoxime AND azithromycin |
|
|
Term
| How should nursing home acquired pneumonia be treated inpatient? |
|
Definition
3 medications IV
1. antipseudomonal - cephalosporin (cefepime), cabapenem (imipemem/cilastatin), B-lactam (piperacillin-tazobactam)
2. antipsudomonal - fluoroquinolone (levofloxacin), aminoglycoside (tobramycin)
3. Anti-MRSA - vancomycin or linezolid |
|
|
Term
| What is the risk of acquiring gonorrhea after 1 encounter? |
|
Definition
male -> female 50-60%
female -> male 20-30% |
|
|
Term
| What culture techniques are used to diagnose gonorrhea? |
|
Definition
male - urethral swab
female - endocervical swab |
|
|
Term
| What lab test is used to diagnose gonorrhea? |
|
Definition
nucleic acid amplification test (NAAT)
used to check for chlamydia too
men - urine
female - endocervical |
|
|
Term
| How do you treat uncomplicated gonorrhea in adults? |
|
Definition
ceftriaxone 250 mg IM once
cefixime 400 mg PO once |
|
|
Term
T/F
N. gonorrhea is increasingly resistant to quinolones in some geographic areas. |
|
Definition
|
|
Term
| How do you treat disseminated gonorrhea in adults? |
|
Definition
hospitalization
ceftriaxone 1 g IM Q24h |
|
|
Term
| How do you treat PID from gonorrhea outpatient? |
|
Definition
ceftriaxone
doxycycline
metronidazole |
|
|
Term
T/F
Concomitant treatment for chlamydia infection should always take place. |
|
Definition
|
|
Term
| How do you treat chlamydia? |
|
Definition
doxycycline 100 mg bid x 7 days
azithromycin 1 g orally once |
|
|
Term
| How do you treat gonorrhea in pregnant women? |
|
Definition
Avoid fluoroquinolones
ceftriaxone 125 mg IM
spectinomycin 2 g IM
cefixime |
|
|
Term
| How do you treat chlamydia in pregnant women? |
|
Definition
| azythromycin or amoxicillin |
|
|
Term
| What is the organism that causes Syphilis? |
|
Definition
Treponema pallidium
a spirochete |
|
|
Term
| What is the risk of transmission of syphilis on a single encounter? |
|
Definition
|
|
Term
| When does the chancre of syphilis form? How long does it last? |
|
Definition
10-90 days (average of 21)
lasts 3-6 weeks |
|
|
Term
| When does secondary syphilis present? |
|
Definition
| 4-10 weeks after primary infection |
|
|
Term
| What is the clinical presentation of secondary syphilis? |
|
Definition
| skin rash, fever, myalgias, malaise, lympadenopathy or mucocutaneous lesions |
|
|
Term
| Which diagnostic tests are used to detect syphilis? |
|
Definition
VDRL - screening
FTA-ABS - confirmation |
|
|
Term
| What is the treatment for acute syphilis? |
|
Definition
penicillin G IM once
if allergy: ceftriaxone IM 8-10 days
or doxycycline po 14 days
or tetracycline po 14 days |
|
|
Term
| What is the treatment for latent syphilis? |
|
Definition
| penicillin G IM 3 doses over 2 weeks |
|
|
Term
| What is the treatment for neurosyphilis? |
|
Definition
benzathine penicillin G IV for 10-14 days
oral doxycycline is NOT appropriate |
|
|
Term
T/F
Congenital syphilis can present itself early or as late as puberty. |
|
Definition
|
|
Term
| What is the treatment for syphilis during pregnancy? |
|
Definition
| Penicillin - it's the only treatment for during pregnancy so desensitize allergic patients |
|
|
Term
T/F
Chlamydia has a high incidence of asymptomatic disease. |
|
Definition
|
|
Term
| What is lymphogranuloma veneruem? |
|
Definition
| another form of Chlamydia that is hard to kill |
|
|
Term
| What is the treatment for lymphogranuloma venerueum? |
|
Definition
DOC: doxycycline 100 mg bid x 21 days
alternative: erythromycin same time |
|
|
Term
| What is the treatment for chlamydia? |
|
Definition
azithromycin once
doxycycline 7 days |
|
|
Term
| What is the treatment for chlamydia during pregnancy? |
|
Definition
azythromycin once
amoxicillin 7 days
alt: erythromycin 7 days |
|
|
Term
| If after treating chlamydia there is persistent urethritis, how do you treat? |
|
Definition
| metronidazole + erythromycin |
|
|
Term
T/F
Most neonates that contract genital herpes die. |
|
Definition
|
|
Term
| What is the treatment for the first episode of genital herpes? |
|
Definition
acyclovir 400 mg tid x 10 days
famciclovir 250 mg tid x 10 days
valacyclovir 1 g bid x 10 days |
|
|
Term
| What is the episodic treatment for genital herpes? |
|
Definition
acyclovir
famciclovir
valacyclovir
half the time |
|
|
Term
| What is the suppressive treatment for genital herpes? |
|
Definition
acyclovir
famciclovir
valacyclovir
treat 1 year then only resume if recurrence |
|
|
Term
T/F
Trichomoniasis is subclinical infection in men. |
|
Definition
|
|
Term
| What is the treatment for trichomoniasis? |
|
Definition
metronidazole 2 g once (no alcohol)
tinidazole 2 g once (no alcohol) |
|
|
Term
| Which types of HPV are associated with 90% of genital warts cases? |
|
Definition
|
|
Term
| Which 2 types of HPV are highly oncogenic? |
|
Definition
|
|
Term
| How many types of HPV are oncogenic? |
|
Definition
|
|
Term
| What % of HPV related cancers are caused by HPV-16? |
|
Definition
|
|
Term
| What is the treatment for genital warts? |
|
Definition
podophyllotoxin gel or solution
imiquimod cream
sinecatechins ointment
cryotherapy |
|
|
Term
| What HPV types are covered in the vaccine? |
|
Definition
|
|
Term
| How many doses are there in the HPV vaccine? |
|
Definition
| 3 doses at 12 week intervals |
|
|
Term
|
Definition
|
|
Term
| What is the treatment for chancroid? |
|
Definition
azythromycin once
ceftriaxone once
Cipro 3 days
erythromycin 7 days |
|
|
Term
| What is the treatment for a superficial genital bite wound? |
|
Definition
|
|
Term
| What is the empiric therapy for genital bite wound? |
|
Definition
|
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